29 March 2011
Midwest Edition
Calendar
April 6-8
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E-Mail
info@payersandproviders.com with
the details of your event, or call
(877) 248-2360, ext. 3. It will be
published in the Calendar section,
space permitting.
To the Ramparts for Health Reform
At 1-Year Mark, Defenders Mount Counterattack
Health reform may be under attack from The crowd, predictably, jumped from the
Republicans and libertarians, but don’t pews to shout and clap.
assume it’s down for the count. At least not At the conclusion of his 10-minute
in Chicago. stemwinder, McNary exulted: “Happy
To celebrate the one-year anniversary of Birthday, Affordable Care Act! May your days
the passage of healthhealthcare-care reform, be long and your troubles be few.”
a coalition of progressive citizens groups and It’s hard to know how long the ACA’s days
political leaders will be, but it’s a sure bet
gathered at the First that its troubles are going
United Methodist to be lasting and
Church at the substantial. Republicans
Chicago Temple on in Congress have made it
March 23 for a pep their highest priority to
rally. overturn the law, or if
“Despite the that’s not possible, to
misinformation, blunt its enforcement by
disinformation, withholding funding or
mendacity, and refusing to enact enabling
outright lies about legislation.
the Affordable Care If they are
Act,” said William E. unsuccessful in the
Katie Jordan, president of the Chicago
McNary, co-director of chapter of the Coalition of Labor Union legislative arena, they
Citizen Action Illinois, Women, addresses the crowd at the expect the courts to
“Insurance companies Chicago Temple on March 23. rule against the
can’t cancel policies mandate to obtain
any more! Ain’t that insurance coverage. A
good news?” number of the nation’s Republican governors
“Seniors are not denied preventive care! are putting roadblocks in place to halt
Ain’t that good news?”
Continued on Next Page
www.lakesidecommunityhealthcare.com
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In Brief
BadgerCare Basic
Enrollments Stopped by
Wisconsin DHS
The Wisconsin Department of
Health Services has halted
enrollment in BadgerCare Basic, a
state health program for low-
income adults without children.
State ofcials said the program,
which opened nine months ago,
was spending far more than it was
bringing in.
The program, which was not
intended to be paid for with
general taxes, is running about $2
million in the red. By the end of
February, it had brought in $4.2
million in premiums and spent
$5.8 million to pays claims. There
are about 6,000 enrolled in the
Basic program.
BadgerCare Basic has also run
through about $1 million in
federal aid that was intended to be
used as a nancial cushion.
Ofcials said they may seek to
increase premiums in the coming
months.
Deaconess Associates
of Cincinnati Receives
$27 Million For Missouri
Nursing Facilities
Deaconess Associations Inc. sold
11 long-term care facilities in
Missouri for $27 million,
according to a report in Senior
Housing News.
Deaconess ran 215-bed
Deaconess Hospital in Cincinnati
until recently, when it ceased
Continued on Page 3
NEWS
Rally (Continued from Page One)
implementation of the various provisions
that affect the states, such as insurance
exchanges.
The 13 speakers underscored all the
things that consumers will get:
* A high-risk pool for those with chronic
diseases, according to Will Wilson, an
advocate for people with HIV and AIDS.
* Coverage for young adults on their
parents’ insurance policies, said Pete
Callahan, head of the SEIU
healthcare workers local.
* “Security, dignity, and
self-respect,” in the words of
John Cameron, political
director of AFSCME, the
public employees union, in
Illinois. He waved a brand
new Blue Cross Blue Shield
card issued to his son, who
became ill while working for
a small employer that didn’t
offer health insurance, and
had been hounded by bill
collectors ever since.
Congresswoman Jan
Schakowsky, a Democrat Rep. Jan Schakowsky
representing Evanston and
the North Side of Chicago,
said she felt “a new narrative sweeping
across the country, a prairie re starting in
Wisconsin,” after the protests in Madison in
February. She denounced “these terrible lies
being spread about Medicare – it’s like elder
abuse.
“We’re going to defend Medicare as a
centerpiece of our values. This legislation is a more receptive political environment for
good for everybody, except maybe the
insurance companies who try to gouge us
every day.
“We are sending a message today that we term, insurance companies won’t be able to
love ObamaCare. It will deliver for the
people of America.”
While the speakers of the event talked
repeatedly about the bill’s enemies – mainly
targeting the health insurance companies --
they did not address the substantive issues
that critics have raised:
* The legislation increases federal
spending to cover the uninsured.
* The insurance mandate may be more
expensive than some employers can afford,
driving them toward dropping insurance all
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Page 2
together.
* The law increases federal oversight of
the healthcare economy and deprives
individuals and companies of the implicit
right not to purchase insurance.
On the same day as the rally, state
legislatures in Florida, Montana, and
Arkansas made clear their intent not to
participate in individual and small business
exchanges, or to work with the federal
government on implementing
other provisions.
The public is still split on
the law. According to a Kaiser
Family Foundation poll in
early March, 42% of
Americans support the law
and 46% oppose it. About
53% of the public said they
are confused about the law.
Of those who oppose the law,
18% dislike the individual
mandate, 19% think
government has too large a
role, and 20% worry about
the costs.
None of that was
mentioned in front of the
175 listeners gathered in the
Methodist church, which is across the street
from City Hall and the Daley Center, named
for the father of the current mayor of Chicago
and founder of Chicago’s famous Democratic
machine. With Democrats holding majorities
in both houses of the legislature, and a newly
elected Democratic governor, Illinois may be
the thrust of the law than most places.
“In 2014,” McNary reminded the crowd,
“in the middle of President Obama’s second
deny coverage.” The event had the feel of a
political prelude, in fact, to the president’s
campaign for re-election in two years.
In other parts of the country, the law’s
sponsors have been making themselves
scarce. Washington Post writer Dana Milbank
observed on the same day that Democrats are
playing “under Marquess of Queensbury
rules, answering the opposition’s often-
scurrilous allegations with earnest pleas not
to ‘relitigate’ the past. In wishing away the
ght, they are losing it.”
Payers & Providers
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*For our ads, not your hospital
In Brief
providing inpatient services at the
hospital.
The buyer of the Missouri
nursing homes was Platinum
Health Care LLC, based in
Skokie, Ill. In all they acquired
852 licensed skilled nursing beds
and 128 assisted living beds,
effective Feb. 1.
In July Deaconess sold ve
other skilled-nursing homes in
Western Missouri. The buyer was
Benchmark Healthcare
Management of Chestereld, Mo.
Deaconess ofcials said they
wanted to devote their efforts to
facilities closer to their base in
southwest Ohio. In 2009 the
company had revenues of $131
million.
Hospitals Contribute
More than $6.1 billion
to Iowa Economy,
Association Says
Iowa's community hospitals
generate more than 137,000 jobs
that add $6.1 billion to the state's
economy, according to a new
study by the Iowa Hospital
Association.
The state's hospitals directly
employ 70,484 people and create
another 67,247 jobs outside the
hospital sector, the study found.
Iowa hospitals provide $3.8
billion in salaries and benets
and generate another $2.3 billion
through other jobs that depend
on hospitals.
"Just as no one provides the
services and community benets
found at our hospitals, there is
also no substitute for the jobs
hospitals provide and create,"
said IHA President and CEO Kirk
Norris.
NEWS
Cook County Health Chief Resigns
Foley was First CEO of Independent Health Board
The CEO of the newly independent Cook
County health and hospitals board in Chicago
will leave his post and take a position with a
private, for-prot hospital operator.
William T. Foley, 60, who became chief of
the Cook County operation in March 2009,
stabilized an organization that had been in
disarray but came under attack from unions,
county commissioners, and members of the
public after he proposed unpopular solutions to
longstanding problems with the county health
system.
One of his initiatives, the planned closing of
underutilized Oak Forest Hospital and its
replacement with an outpatient clinic, was
vetoed by the state’s certicate of need board
on March 21. County health ofcials had been
working on the plan for more than a year, and
counting on $25 million in savings to fund
other projects.
The county health system provides care for
about 800,000 residents who have no
insurance, on a budget of around $900 million
a year. It operates Stroger Hospital, which
replaced the old Cook County Hospital 10
years ago, as well as Provident Hospital on the
South Side and the Oak Forest hospital, as well
as many community clinics. Oak Forest has an
occupancy rate of around 30% and Provident,
50%. Stroger is also underutilized.
The Chicago Tribune editorialized last week
in favor of the Oak Forest plan, reminding
MA Plan Enrollment Rises to 24%
Medicare Drug Plan Coverage Hits 60%
Enmrollment in Medicare Advantage plans
increased to 11.4 million people in 2010, or
24% of all Medicare beneciaries, the
Medicare Payment Advisory Commission said
in March. Enrollment in HMOs, the dominant
type of MA plan, rose 7%, while local PPO
enrollment grew by 40%.
On average, beneciaries may choose
from 12 plans.
The federal government is paying 10%
more for beneciaries enrolled in Medicare
Advantage programs than if those persons had
been enrolled in fee-for-service Medicare,
MedPAC said. This has long been a bone of
!!!"#$$!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Page 3
readers that “Cook County taxpayers picked
up the tab for one of the most spectacularly
mismanaged public health systems in the
country.” The health system was separated
from direct control by the Cook County
Commission several years ago, in hopes of
achieving management independence,
nancial accountability, and a diminishment
of patronage hiring.
Even so, Foley and his managers came
under withering criticism from established
political interests. A union nurse said, “They
are getting rid of frontline workers, and
increasing the managers and consultants, and
sucking money out of the system.” Foley and
his management team were called “pin-striped
pimps” by a Chicago alderman. These attacks
took their toll, Foley’s supporters said.
County Commissioner Larry Suffredin said
he was disappointed that Foley left so soon in
his tenure. “We are not a system in crisis, as
we were three years ago,” he told WBEZ,
Chicago public radio. “We are a system that is
functioning but needs to be tended to every
day.”
Foley, 60, has accepted a position as CEO
running hospitals in Chicago for Vanguard
Health Systems.
Cook County Board President Toni
Preckwinkle said a nationwide search would
be conducted to nd “a committed public
servant” to replace Foley.
contention between congressional
Democrats, who see this as an unwarranted
public subsidy of managed care plans, and
Republicans, who view Medicare Advantage
as a worthy reform.
About 28 million beneciaries were
enrolled in Part D pharmaceutical benet
plans in 2010, or 60% of the total. About 10
million of those (36% of enrollees) got a low-
income subsidy.
Beneciaries on haver have from 28 to 38
Part D options to choose from. For the basic
benet, CMS estimates the average monthly
premium rose $1 from 2010, to $30.
Payers & Providers OPINION Page 4

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Berwick’s Fate Should Take High Road
Senate Ought to Give CMS Nominee a Fair Hearing
The political fracas over Don Berwick’s
appointment as director of the Centers for
Medicare & Medicaid Services (CMS) is a
disturbing indication of the political decline of hand and several ngers of the other tied behind
America.
Berwick is a brilliant Harvard professor and
founding head of the Institute for
Healthcare Improvement. He is
also the brains and vision
behind most of the important
healthcare initiatives of the past
generation, from the IOM
reports on quality and safety, to
“bundles” of evidence-based
practices to reduce harm, to the
idea of a campaign to promote
patient safety.
President Obama’s selection
of Berwick to lead CMS last year
was inspired. In the face of
unassailable evidence of spotty
quality and safety, unjustiable By Robert Wachter, M.D. concerns about his qualications
variations in care, and impending
insolvency, Medicare has no choice but to
transform itself from a “dumb payer” into an
organization that promotes excellence in
quality, safety, and efciency. There is simply no recent his testimony before the House Ways and
other person with the deep knowledge of the
system and the trust of so many key
stakeholders as Don Berwick.
But Berwick’s nomination ran into the buzz
saw of Red and Blue politics, with Republicans have been once-in-a-lifetime opportunities to
holding his nomination hostage to their larger
concerns about the Affordable Care Act. In the
ludicrous debate that ultimately culminated in
Obama’s recess appointment of Berwick, the
central argument against his nomination was
that he had once – gasp – praised the UK’s
National Health Service.
President Obama was right to use his recess the best hope we have to improve our healthcare
appointment power to install Berwick as CMS
director. I hoped – naively, perhaps – that Don
would win over his critics by the time his
appointment expired in December 2011. And,
in his eight months in the role, Berwick has
done a terric job. As always, his speeches on
healthcare reform have been articulate and
thought provoking (though one can see a heavy
bureaucratic hand tamping down Don’s
characteristic air and penchant for
provocativeness). He has appointed excellent
people to key leadership positions, eshed out
some of the new CMS programs such as Value-
based Purchasing and the Innovations Center,
and will announce a major initiative in patient
safety in the near future. Impressively, Berwick
has accomplished all of this with at least one
his back: doubt about his own future at CMS,
uncertainty about the fate of the Affordable Care
Act, and an unrelentingly hostile
reception by the Republicans in
Congress.
But my hopes were dashed by
the recent statement by Sen. Max
Baucus (D-Montana) that
Berwick is simply not
conrmable by the Senate. This
announcement followed a letter
sent to the White House by 42
GOP senators, who argued –
disingenuously – that Berwick’s
“lack of experience in the areas
of health plan operations and
insurance regulation raise serious
for this position.”
From the moment of his nomination, Berwick’s
plight has been a sad spectacle. I was particularly
disheartened by the way he was treated before his
Means Committee.
In the face of this kind of nonsense, I know of
several superb physician-leaders who were
offered positions in CMS – for roles that should
shape national policy – but turned them down.
“Who needs this?” one told me. And they’re right.
The smart money is that the White House will
fold on the Berwick appointment. Let’s do what
we can to turn this around. Please contact the
White House, your senators and representatives,
and the media, and tell them that Don Berwick is
system. Tell them that the Senate should hold
hearings on his appointment, and let the chips fall
where they may.
Robert Wachter, M.D., is a professor of
medicine at the University of California San
Francisco and chief of the division of hospital
medicine in the UCSF Medical Center. He is a
nationally recognized expert on healthcare
quality and blogs at http://community.the-
hospitalist.org/blogs/default.aspx, from which
this op-ed was adapted.

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Payers & Providers MARKETPLACE/EMPLOYMENT Page 5

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*New England Journal of Medicine, 2004.

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